In connection with my application for coaching, I understand that an investigative consumer report may be requested that will include information as to my character, work habits, performance and experience.I understand that as directed by Jefferson County Midget Football Association and JMFA you may be requesting information from public and private sources about my:court record, credentials, references.

I acknowledge that a telephonic facsimile (FAX) or photographic copy shall be as valid as the original.This release is valid for most federal, state and county agencies.

I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer reference or insurance company contacted by Jefferson County Midget Football Association or its agent, to furnish the information described above.

The following information is required by law enforcement agencies and other entities for positive identification purposes when checking public records.It is confidential and will not be used for any other purposes. I hereby release JMFA and agents and all personal agencies, and entities providing information or reports about me from any and all liability arising out of the requests for or release of any of the above mentioned information or reports.